Platelet Rich Plasma: Immunomodulatory and Anti-Inflammatory Pain Relief

If you’re like a lot of patients with arthritic knee pain, you’ve probably seen and heard a lot about platelet rich plasma (PRP) as a potential treatment option. While PRP use has become routine in everyday sports medicine clinics nationwide, there continues to be too much misinformation about what PRP is and how it works. There are times when it makes sense to use PRP, and then there are other times. The educated consumer and patient needs to be armed with this information to be able to make the best informed choice for themselves.

PRP preparations vary widely and depend on many factors. The most important thing patients should look for is an orthopedic surgeon who is an expert in regenerative biologics and cell transplantation. Through their expertise from treating non-surgical and surgical patients, they are ideally poised to determine the PRP preparation that is best for each patient on an individual basis.

The PRP that we have always used for our patients with orthopedic and musculoskeletal problems is the most scientifically appropriate concentration for the treatment of pain. While most preparations focus on just concentrating platelets and growth factors, we have found that it’s more likely that the true molecular key to relief actually resides in the blood plasma itself.

Platelets are fragments of larger cells called megakaryocytes. Platelets contain concentrated growth factors that play a functional role in cell and tissue regeneration. These growth factors are important for day-to-day tissue homeostasis and in the setting of tissue injury. Tissue regeneration will not proceed without these critical growth factors.

Tissue Injury and Response

Tissue damage is a chemical event, and tissue healing is a chemical event. Typically, a phospholipid bilayer membrane surrounds and protects healthy cells. When cells are injured by hypoxia, chemical, physical or metabolic insult, the protective bilayer is compromised and intracellular structural proteins escape into the extracellular space. These structural proteins then become signaling proteins at that point because they signal to circulating inflammatory, dendritic and immune cells that there has been a cell/tissue insult. This is accomplished through cell receptor mediated signaling. The soluble signaling molecules lock into an immune cell receptor where transmembrane signaling cascades prompt cellular machinery to favor an anabolic metabolism and the elaboration of structural proteins.

Dual Roles of PRP

A carefully controlled and redundant, complex molecular interplay of signaling cascades that vary in spatiotemporal orientation guides tissue maintenance and regeneration after injury. Biochemical environmental cues lead to an organization of the PRP growth factor “storm,” and tissue rebuilding machinery favors anabolic metabolism.

The body’s response to PRP treatment is native. The platelet concentration in PRP exposes the healing environment to 4-8x the growth factor volume found in whole blood. Growth factors bind to cell membrane receptors where they are able to initiate sequencing cascades that produce functional and signaling proteins.

The extracellular matrix (ECM) structure is formed by the cells themselves into a “reef” that the cells intricately associate with one another. Molecular signals snake through the nanotubular maze of molecular soup where a cytokine storm is waging. Cytokines control the cellular environment and direct metabolism to a regenerative (anti-inflammatory) or degenerative (inflammatory) state.

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